Manager, Physician Revenue Integrity

The Manager, Physician Revenue Integrity is responsible for overseeing revenue integrity operations across the physician enterprise, including ambulatory clinics, provider-based practices, and specialty services. This role ensures accurate and compliant charge capture, coding, reconciliation, and audit readiness for all professional services. It blends operational leadership with financial analysis responsibilities to optimize revenue generation, reduce denials, and maintain alignment with payer and regulatory requirements.

By integrating charge audit oversight, denials prevention, and real-time financial performance reporting, this position supports providers and administrators in achieving high

Physician Revenue Operations Oversight

• Direct and manage charge capture, reconciliation, chart review editing, and work queue monitoring for all physician specialties and care models.
• Lead daily revenue cycle activities in partnership with clinic managers, coders, providers, and billing teams to ensure timely and accurate claims submission.
• Identify gaps in provider documentation and collaborate with clinical operations and coding staff to implement improvements.

Denials Prevention & Government Audit Readiness

• Lead initiatives to identify and reduce avoidable denials specific to professional billing and modifier usage.
• Monitor payer trends, bundling edits, and specialty-specific denials to proactively educate providers and billing teams.
• Coordinate responses to Medicare and Medicaid audits (e.g., TPE, CERT) and payer inquiries across ambulatory practices.

Outreach, Training & Policy Leadership

• Conduct ongoing department outreach to reinforce revenue integrity standards with operational and clinical leaders.
• Design and deliver training on charge capture workflows, coding accuracy, and denial prevention to front-office, clinical, and billing staff.
• Develop and maintain policies and procedures that ensure compliance with payer rules, specialty-specific coding requirements, and CMS guidelines.

Financial Analysis & Reporting

• Analyze performance metrics such as charge lag, denial rate, net collection rate, and provider documentation accuracy.
• Prepare and present financial reports, dashboards, and trend analyses to senior management and physician enterprise leadership.
• Conduct cost-benefit analyses for proposed billing process changes, technology implementations, or resource adjustments.

Collaboration & System Integration

• Serve as the primary liaison between physician practices, revenue cycle operations, compliance, and coding leadership.
• Partner with Epic analysts, clinic managers, and financial analysts to ensure workflows are standardized, measurable, and optimized.
• Support implementation of charge automation tools, reconciliation dashboards, and documentation improvement initiatives.
• Education:

Bachelor's degree in Healthcare Administration, Business, Finance, or a related field required. Master's degree preferred.

• Experience:

o Minimum 5 years of experience in physician revenue integrity, billing operations, or revenue cycle leadership.

o Strong understanding of E/M services, surgical/procedural coding, modifiers, split/shared visits, and payor billing rules.

o Experience working with Epic (or similar EHR) and physician billing workflows highly preferred.

• Skills & Competencies:

o Excellent knowledge of CPT, HCPCS, ICD-10, and professional billing guidelines.

o Advanced Excel and analytical skills; experience producing KPIs and actionable financial reports.

o Outstanding communication and interpersonal skills, with the ability to engage both front-line and executive audiences.

o Strong organizational skills with the ability to manage cross-functional projects and training programs.

• Preferred Certifications:

CPC, COC, CPMA, or RHIA strongly preferred.

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Working Conditions:

• Primarily office-based with regular support to physician clinics and administrative offices.
• Requires frequent interaction with providers